Monday, August 25, 2008

Jackson Hole, Wyo.- On a cloudless December night in a small town in South Dakota, Julie was curled in a ball in a snowdrift, her gloves and hat littered across the parking lot. She had emptied one whiskey bottle and was working through the second - enough, she hoped, to end her pregnancy. If it didn’t, she’d have to try something else.

Julie, which is not her real name, agreed to tell her story but declined to reveal her identity in order to protect her privacy.

Julie, 21, was single, in debt from the birth of her first son, and working a desk job at $5.65 an hour. She knew that if she asked for time off - either to have an abortion or to take care of a newborn - that she would lose her job.

“I couldn’t feed the son I already had,” she said. “So I did what I could do.”

By her estimates, getting to Sioux Falls - some 300 miles away - for a “doctor abortion” would have cost her $660, including $100 for gas, $60 for a hotel and $500 for the procedure itself. She would have needed a car, which she didn’t have, and two days off of work to wait out the state-mandated, 24-hour waiting period. Time and money were resources she simply had no access to.

Her friend bought the whiskey for her, and Julie took it to the high school parking lot after putting her 2-year-old to bed.

“I drank [the pregnancy] to death under the basketball hoop,” she said. “I nearly drank me dead, too. I had to find that balance between it dying and me dying, you know?”

Her friend took her to the hospital for alcohol poisoning once the whiskey - and, they figured, the pregnancy - was gone.

“It worked,” Julie said about the incident, now nearly two years behind her. “I’ve told a few girls it works.”

Empty frontiers

Julie is one of a growing number of women living in the West without an abortion provider within 100 miles.

Since 1982, the number of abortion providers in the United States has fallen by 37 percent. Of the remaining practitioners, 57 percent are older than 50 and are expected to retire within the next decade, according to Medical Students for Choice, a group founded in 1993 on the belief that “one of the greatest obstacles to safe abortion today is the absence of trained providers.”

The ‘graying of the profession’ is already affecting the West, which struggles with attracting and keeping physicians in its rural areas and has seen dramatic declines in abortion providers over the past two decades.

At the height of abortion services in the state of Wyoming, from 1981 to 1985, there were eight providers, according to the Guttmacher Institute, a nonprofit organization for sexual and reproductive health research. About 1,000 abortions a year were performed in Wyoming during that time.

After 1985, provider numbers began to drop as doctors retired but were not replaced. By 1988, a study found that the majority of women were leaving Wyoming to procure abortions. This report from the Center for Disease Control and Prevention showed that while only 188 abortions were performed in the state that year, 902 women who identified themselves as Wyoming residents had obtained abortions somewhere in the country.

By 2005, two abortion providers remained in Wyoming, and 70 abortions were recorded in the state. Now, a single advertised abortion provider is left: Dr. Brent Blue, a family practitioner at Emerg-A-Care in Jackson Hole. There may be other Wyoming providers, however, who don’t advertise their abortion services and limit them to their own patients.

A class of its own

The retiring generation of abortion providers is largely comprised of general and family practice physicians who were studying or practicing medicine both before and after Roe v. Wade made abortion legal in the U.S. in 1973.

Many doctors of this era do not consider themselves activists. Rather, they call themselves ‘community doctors,’ and they consider abortion a small but integral part of providing full-service medical care.

“As far as I’m concerned, it’s part of a family practice,” Blue said. “It’s part of medicine. It’s no different from vasectomy services and no different than delivery services. … It is not a political issue.”

Blue’s clinic in Jackson Hole was bombed in 1995 by Richard Thomas Andrews, an anti-abortion activist who later pleaded guilty to bombing abortion clinics in California, Montana and Idaho. Still, Blue said that he pays “very little attention” to opposition.

Edward Boas, one of the few remaining family practice physicians to provide abortions in Boise, Idaho, said he is not an upstart by any means.

“I’m not gonna go marchin’,” he said. “I have done surgery all my life and this is a minor little surgical procedure. … It’s part of the medical world and somebody’s got to do it.”

The toll of travel

Even though an estimated 35 percent of U.S. women will have at least one abortion by age 45, about 87 percent of the nation’s counties currently have no provider, according to the Guttmacher Institute.

In the Western census region, where Wyoming is located, 18 percent of women having abortions in 2005 reported traveling more than 50 miles and 5 percent traveled more than 100 miles.

In other Western states, some women report traveling 300 miles or more.Planned Parenthood’s Wyoming Abortion Fund has provided more than 200 women with financial assistance, paid directly to the provider, since its creation in October 2004. The fund will assist Wyoming residents with lodging, day care, and travel to other states, as is often necessary. Another fund, called Women for Women, also helps Wyoming residents.

An abortion at Emerg-A-Care in Jackson Hole costs $1,045, cash only, and insurance is not accepted. The abortion funds in the state may provide $500 in total toward this cost.

Boas, in Idaho, charges $450 for the procedure.

The Hyde Amendment denies federal Medicaid funding for abortions except in cases of rape, incest or life endangerment.

No replacements

Boas, like many Western family practice doctors, believes that no one will take his place performing safe, legal abortions when he retires. Just recently, there were three providers in Idaho. But one retired last year, Boas is retiring in December and the final provider “is not really that into doing it,” he said.

Unless there are abortion providers working under the radar in Idaho - which Boas doubts, based on the cost of ultrasound and other equipment - it could be the end of an era for the state.

“Guys like me, I started doing it when I was about 50,” Boas said. By then, he was established in the community and unconcerned about losing business by providing abortions to women who wanted them.

Doctors who are just graduating from medical school and creating their practices may more worried about what people think, he said.

One Western abortion provider, who asked not to be named, said that state legal restrictions saddle the procedure with so many regulations that some doctors are wary to become involved, even if they have no qualms about abortion itself.

“There is also the issue of reporting terminations,” the doctor said. “New graduates are going to be more worried about the laws than maybe us old doctors are. They think of the law as bigger than it is.”

Wyoming has parental notification laws that require that the parent of a minor consent before an abortion can be provided. There have also been repeated attempts in the Legislature to create a state-written script that doctors must recite to a patient before performing the procedure. The script included phrases medical professionals called “insulting, patronizing and unscientific,” such as linking abortions to breast cancer. The bill was most recently defeated in 2007.

Blue just smiled at the idea of a mandated script. “What I say to a patient is no one’s business but mine and the patient’s,” he said.

Other doctors are afraid that if they provide abortions they will be pigeonholed as “abortion doctors” rather than doctors providing a full range of services. Some doctors are concerned about being stigmatized within the medical community, said Sharon Breitweiser of NARAL Pro-Choice Wyoming.

Other doctors, say anti-abortion groups, simply think it’s wrong.

Lack of medical school training

Even if medical students want to be trained in surgical abortion procedures, some have little opportunity. Between 1978 and 1995, the number of medical programs providing routine abortion training to residents dropped from 26 percent to 12 percent, according to Guttmacher data.

“Medical schools across the country just are not teaching the service, so when people are presenting at emergency rooms … they’re not providing abortion services,” said Katie Groke, a field manager at Planned Parenthood of the Rocky Mountains. “They don’t know how.”

It is possible that surgical abortions will decrease as surgical training opportunities flounder but that medical abortions with RU-486, the so-called “abortion pill,” will increase in the future, some medical professionals said.

Medical Students for Choice was formed in the 1990s to address the dearth of training, but it has “had trouble catching on in the West,” where most doctors are “funneled” to the University of Washington Medical School to complete their residencies and where abortion training is “severely lacking,” said a member of the group.

Officials at the medical school did not return calls for comment.

Boas is connected to the organization. “I go to these meetings that are nationwide, and you get about 12 to 15 of these kids in training,” he said. “They’re different now than we are. Most of them are girls.”He would be happy to pass his knowledge along to another Idaho doctor.“Hell, I could teach somebody to do one in two days,” he said. “It’s not brain surgery.”

Few ‘abortion clinics’

As these providers retire, their services are rarely replaced by ‘abortion clinics’ in the West, which are defined as clinics where abortions make up more than 50 percent of provided services.

Abortion clinics are typically established in city centers with dense populations, which the West lacks. Further, Planned Parenthood officials said the pool of abortion providers in some Western states is too small to provide enough doctors to operate a clinic.

A few clinics operate without local doctors. South Dakota’s single abortion clinic, on the far eastern side of the state in Sioux Falls, flies doctors in to provide abortions a few hours a week.

The doctors “have security from the moment they step into South Dakota until the moment they leave,” said Kathi Di Nicola, Director of Media Relations for the Planned Parenthood clinic. “They just have to.”

Three out of four doctors are “seasoned,” said Di Nicola, and one provider, identified in the media as Dr. Miriam McCreary from Minneapolis, came out of retirement just to provide termination services in a state where none of its own doctors are willing to do so.

One of the biggest challenges is what to do next if any of these doctors retire from the clinic, Di Nicola said. “They won’t be easy to replace.”

Planned Parenthood’s abortion clinics aren’t attractive options to medical professionals like Boas, who defines himself as a generalist and a community doctor rather than ‘an abortion doctor.’

“They tried to recruit me to come to Spokane … but I turned it down,” Boas said. “That’s itinerant medicine. I don’t really like it.”

The end of an era

Boas said he believes “we’re seeing the last days of Roe v. Wade.”

Even if abortion remains legal, it could become inaccessible, he said. If there are enough barriers placed between a woman and a doctor, like in Julie’s case, the two may never connect.

“These anti-abortionists, they’ll chip away at it until it will eventually collapse,” Boas said. “Finally the providers are going to say, ‘I’ve had enough of this and I can’t do it anymore.’ I guess I’m glad I’m retiring.”

Wednesday, August 13, 2008

The Democratic Party platform of 2008 finally dropped its old abortion language ("safe, legal and rare"), which had asked that women not have abortions unless they absolutely must. The 2008 platform, just announced, says instead, "The Democratic Party strongly and unequivocally supports Roe v. Wade and a woman's right to choose a safe and legal abortion, regardless of ability to pay, and we oppose any and all efforts to weaken or undermine that right." Should a woman desire to bear her child, the Dems advocate prenatal care, income support, and adoption programs to help her there, too. But in the world of the new Democratic platform, it's the woman's decision to make.

In 1973, the Supreme Court ruled by a margin of 7-2 in Roe v. Wade that women—not their husbands, their doctors, or their legislatures—must be the ones to decide whether to bear or beget a child. Edward Lazarus, who clerked for the author of that opinion, Justice Harry Blackmun, called the decision "the Emancipation Proclamation for American women." But if Roe was Emancipation, the past three decades have felt like the Jim Crow South. Unable to repeal the decision itself, opponents made abortion as illegitimate as possible. The Hyde Amendment pulled Medicaid financing for the poorest and most desperate women. In 1992, the Clinton campaign reframed abortion as an unpleasant last resort. Last term, the Supreme Court finally broke, affirming the criminalization of certain late-term abortions. And Democratic candidate Barack Obama, in The Audacity of Hope, compared women's regrets over their past abortions to white people's regrets about past bigotry. This Clintonian compromise—that abortion was a necessary moral evil—had become the most progressives could hope for.

With the release of the new platform, and so long as the Obama campaign doesn't cast the platform into purgatory and pick an anti-abortion candidate—like Virginia Gov. Tim Kaine—for vice president, the emancipation of women may once again become a legitimate political position. It is time to revive the moral argument for protecting a woman's right to choose: Abortion is about the value of women's lives.

Liberals have never won anything by reframing moral questions as pragmatic ones; they end up looking shifty and evasive. Whatever else it has been doing, the Supreme Court has always framed its decisions about the legality of abortion in moral terms. The decision in Roe to protect women's reproductive choices grew out of earlier cases protecting ordinary means of birth control as a matter of "privacy." It was only over the course of its long philosophical evolution on abortion that the court silently changed the meaning of privacy from the morally neutral secrecy to autonomy, a moral claim for the individual's right to shape her own life.

When, in 1986, Justice Byron White attempted to argue that disputed questions of abortion were best resolved by referring these questions to the states, Justice John Paul Stevens insisted that the only proper decision-maker in such a crucial matter was the mother. Similarly, in their landmark 1992 abortion decision in Planned Parenthood v. Casey, Justices Sandra Day O'Connor, Anthony Kennedy, and David Souter agreed that "at the heart of liberty is the right to define one's own concept of existence, of meaning, of the universe, and of the mystery of human life."

The gay-rights movement best illuminates the need to emphasize the role of morality in politics. In 1986, the Supreme Court decided Bowers v. Hardwick, upholding the constitutionality of criminal penalties for gay sodomy. Choice, said the five-justice majority, although available for a wide range of decisions (including abortion), was not available for conduct we consider really, really icky. (They didn't say that explicitly; they put the words in the mouth of the "Judeo-Christian" tradition and let the priests say it for them.) Just as Bowers was decided, however, the AIDS epidemic motivated and enabled gay people to tell the world why their behavior was moral. As gay men began to die, they and their loved ones began to write about their relationships, their shared homes, and their desire—going back to Homer—to bury those they loved. At the same time, lesbians, who had been fighting for their children after divorces and for the families they were creating with donor insemination—publicly told the story of their own moral commitments.

By the time the Supreme Court faced the previously sinful gay litigants again in Lawrence v. Texas, 17 years later, the decision went the other way. It is impossible to read the two opinions and ignore the change in moral climate that produced the legal shift. And although recent polling fails to reveal a majority supporting gay marriage, the numbers have been steadily improving.

After 30 years of ghastly representations of abortion by the right and weak-kneed defenses by the left, one would expect public support for abortion to have plummeted. Although most polling experts contend that American beliefs about abortion have been roughly stable, the deeper picture is ominous. About 20 percent of those polled believe abortion should never be allowed, and about 20 percent think it should always be allowed. About 60 percent think it should be allowed under certain limited circumstances.

If you unpack that crucial 60 percent, however, even these "centrists" only firmly support abortion in cases in which there is rape, incest, or a threat to the mother's life or health. Just over half of them support abortion in the case of physical or mental defects in the prospective baby. And when asked whether a woman should abort if she or her family could not afford to raise the child, the support for abortion drops to 35 percent.

This polling data represents the price of progressives' refusal to make the moral argument. Women bear the overwhelming majority of child-rearing responsibility in this society. Yet barely more than half of the moderate centrists would allow them to decide whether to abort—even in face of a physical or mental defect in the prospective child. Women, whose economic prospects plummet with the birth of a child, now face 65 percent majorities who would support criminalizing their decision to abort because they are too poor for parenthood. Guttmacher Institute abortion numbers reveal that these same poor women are disproportionately black and Hispanic. It is fair to conclude that a lot of abortions, regardless of race, are about women seeking the flourishing life prospects that our current morality-free discourse completely conceals.

In the 30-some years since Roe v. Wade, somewhere between 18 million and 30 million American women—15 percent to 20 percent of the female American population—have terminated their pregnancies. More than 10 years ago, a movement I'll call the Post-Abortion Syndrome movement began to shift the argument against abortion to the harm done to women. Not surprisingly, in a population of many millions, the PAS movement found a few thousand women who signed affidavits about their regrets at having had abortions.

Last year, in Gonzalez v. Carhart, the Supreme Court, for the first time, upheld the constitutionality of a federal law criminalizing a type of abortion. In his opinion for the court, Justice Kennedy wrote that "Respect for human life finds an ultimate expression in the bond of love the mother has for her child ... it seems unexceptionable to conclude some women come to regret their choice to abort the infant life they once created and sustained. Severe depression and loss of esteem can follow." In Kennedy's view it was best to spare women such regrets. Indeed it was better still not to allow doctors to perform these procedures at all.

Others have dissected Justice Kennedy's bizarre logic in detail. But what most have missed is that his opinion in Carhart rested on the assumption, ceded so long ago by liberals, that abortions are a necessary evil. There is no serious scientific evidence for any of the justice's findings that a remotely cognizable percentage of the 18 million to 30 million living American abortion recipients have suffered regret, severe depression, and loss of esteem. The American Psychiatric Association has directly refuted any such claim time and again. Why, then, did Justice Kennedy feel so comfortable—indeed, "unexceptionable" —in asserting it? Why, more interestingly, did the Democratic candidate for president similarly invoke the image of the "middle-aged feminist who regrets her abortion" in The Audacity of Hope?

Because they suspect abortion is morally wrong. In the absence of a robust description of the value of women's lives—their ability to develop their capacities through education, to use them to achieve economic independence and political citizenship, to take on only the relationships they can manage—there is no moral argument for their "choice" to have an abortion. Set against the sound of nothing, the smallest moral claim of the potential human life looms large. Such an immoral act, moral thinkers conclude, must always be a mistake, the product of incomplete information or logic, and, in time, must produce regret, depression, and loss of self-esteem.

The wrong question will always lead to the wrong answer. Not coincidentally, the founding text of the Post-Abortion Syndrome movement is called "Making Abortion Rare." The Democratic platform of 2008 offers an opportunity to put an end to this self-destructive cycle of Safe, Legal, and Rare, otherwise known as regret, depression, and self-denigration. In its place, it can finally argue for the value of women's lives. Above rubies sounds about right to me.

Friday, August 8, 2008

A Russian advertising executive who sued her boss for sexual harassment lost her case after a judge ruled that employers were obliged to make passes at female staff to ensure the survival of the human race.

The unnamed executive, a 22-year-old from St Petersburg, had been hoping to become only the third woman in Russia's history to bring a successful sexual harassment action against a male employer.

She alleged she had been locked out of her office after she refused to have intimate relations with her 47-year-old boss.

"He always demanded that female workers signalled to him with their eyes that they desperately wanted to be laid on the boardroom table as soon as he gave the word," she earlier told the court. "I didn't realise at first that he wasn't speaking metaphorically."

The judge said he threw out the case not through lack of evidence but because the employer had acted gallantly rather than criminally.

"If we had no sexual harassment we would have no children," the judge ruled.

Since Soviet times, sexual harassment in Russia has become an accepted part of life in the office, work place and university lecture room.

According to a recent survey, 100 per cent of female professionals said they had been subjected to sexual harassment by their bosses, 32 per cent said they had had intercourse with them at least once and another seven per cent claimed to have been raped.

Eighty per cent of those who participated in the survey said they did not believe it possible to win promotion without engaging in sexual relations with their male superiors.

Women also report that it is common to be browbeaten into sex during job interviews, while female students regularly complain that university professors trade high marks for sexual favours.

Only two women have won sexual harassment cases since the collapse of the Soviet Union, one in 1993 and the other in 1997.

Human rights activists say that Russian women remain second-class citizens and are subjected to some of the highest levels of domestic abuse in the world.

Monday, August 4, 2008

Herewith a suggestion on how to improve the South Dakota Fairy Tale that the U.S. Court of Appeals for the 8th Circuit has approved for reading to women before they undergo abortions. The case was Planned Parenthood Minnesota, North Dakota, South Dakota, et al vs. Mike Rounds, et al. It pertained to a piece of legislation passed by the South Dakota legislature, a mostly male body that has, until now, unsuccessfully tried to tell women what they may and may not do with their bodies. Thanks to the Court it has finally succeeded.

The essence of the case was that although women may continue to get abortions in South Dakota, the physician performing the procedure is required to read aloud to the prospective mother. Under section 7 of the statute a woman is required to receive oral disclosures about the procedure she is about to undergo. Some of the information must be given orally AND in writing and other information only in writing although the language of the statute can be read to require that all information must be imparted orally by the physician.

Although the prescribed reading (and writing) is not the sort of thing the mother would read aloud to the child were the child to be born, it has a certain fairy tale like quality to it. Among the things the physician is required to tell the mother is that an abortion will “terminate the life of a whole, separate, unique, living human being,” that the woman has an “existing relationship with that unborn human being, ” that the relationship enjoys protection under the United States constitution and under laws of South Dakota” and that “by having an abortion, her existing relationship and her existing constitutional rights with regards to that relationship will be terminated.”

It is patently absurd to describe the embryo has a “whole” and a “separate” human being since whatever else it may be, it is neither whole, having many months to go before it achieves that state, nor is it “separate” since ordinarily it cannot survive outside the mother’s body at the time the abortion is performed. It is equally absurd to say that the “relationship” “enjoys protection under the United States Constitution” since it does not.

Sarah Stoesz, president of the regional Planned Parenthood office, said the statute represents an “unprecedented interference in the doctor-patient relationship and unprecedented interference in a woman’s life.” She also observed that the law is “non-science” based but as we have been taught by none other than the president of the United States and his minions, science is an elective subject whose proofs one may accept or reject based on one’s personal biases. And speaking of science, we are brought to the Environmental Protection Agency’s most recent pronouncement that if added to the South Dakota statute, will bring the number of abortions performed in South Dakota to zero.

The E.P.A. issued a report on July 19, 2008 that pertained to a matter with which few people knew the E.P.A. was concerned. The report said the value of a human life has gone down from $8.04 million to $7.22 million. That does not mean, as the report is careful to point out, that every reader of this column is worth that. Some will be worth more and others less and most readers know to which group they belong.

The reason it is important to know the value of a human life is that when you have the answer to that question you can decide whether certain governmental actions are worthwhile. If something is proposed that a governmental agency determines will save 50 lives and cost $500 million, the agency determines if the proposal makes sense by multiplying 50 lives times $7.22 million. If the product is less than $500 million, the project is abandoned and if more, it may be implemented. If, in that example, 200 people were affected, then the math would justify the cost.

Now that this information is available, the South Dakota legislature should promptly amend House Bill 1166 to include a requirement that the fairy tale be refined to add a section that will inform the woman that not only is she “terminating the life of a whole, separate, unique, living human being” but she is also disposing of an asset that has a scientifically established value of $7.22 million. Armed with that scientifically correct information most women will immediately spring for the cash and abortions in South Dakota will come to an end. There will, of course, be a modicum of disappointment when the kid hits college age and the parent goes looking for the $7.22 million the parent knows was being stowed away. Parents will find, to their dismay, that the $7.22 million was, like much of the rest of the language in the South Dakota Fairy Tale, made up by ignorant busy bodies more interested in controlling women’s bodies than in educating their proprietors.